NPIMap

Individual provider Active NPI

Mark Edward Van Wormer, MD

  • General Practice Physician
  • Clayton, NM
National Provider Identifier
1013919034
Registry record updated Jul 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
81333 Issued in NM
Practice address
314 N 3Rd Ave
Clayton, NM 88415-3302
Phone
(575) 374-8313
Fax
(575) 374-2064
NPI assigned
Aug 10, 2005
Last updated
Jul 15, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 81333 NM Primary

Addresses

Primary practice location

314 N 3Rd Ave
Clayton, NM 88415-3302

Mailing address

314 N 3Rd Ave
Clayton, NM 88415-3302
Phone (575) 374-8313

Other identifiers 2

IdentifierTypeStateIssuer
060000475OtherRAILROAD MEDICARE
05645MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081210000476 NM Practitioner - General Practice 4183785041 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clayton Health Systems IncGroup PAC ID 0941195895, shared by 5 NPIs, 5 clinicians

Practice addresses (Care Compare)

314 N 3Rd Ave
Clayton, NM 88415-3302
Phone (505) 374-2273

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.99 of 100Reported as group
Quality
63.82
Promoting interoperability
98
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
81333NMMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Clayton Health Systems Inc CurrentSince Dec 19, 2017 Accepting new patients
Clayton Health Systems Inc Current Accepting new patients
Clayton Health Systems, Inc CurrentSince Dec 19, 2017 Accepting new patients
High Plains Radiological Association LLP Past Accepting new patients
Clayton Health Systems, Inc Past Accepting new patients
419 Harding Street Operation LLC PastSince Feb 1, 2025 Accepting new patients

Locations

300 Wilson St
Clayton, NM 88415
Phone (575) 374-2585

301 Harding St
Clayton, NM 88415
Phone (505) 374-2585

314 N 3rd Ave
Clayton, NM 88415
Phone (575) 374-2273

315 N 3rd Ave
Clayton, NM 88415
Phone (505) 374-2273

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/unionco-05843333

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Union County General HospitalClayton, NM, CCN 321304 Hospital Operational/Managerial Control May 29, 2018
Union County General HospitalClayton, NM, CCN 32Z304 Hospital Operational/Managerial Control May 29, 2018
Clayton Nursing and RehabClayton, NM, CCN 325100 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 1, 2024
Feb 1, 2025
Union County General HospitalDes Moines, NM, CCN 323414 Rural health clinic W-2 Managing Employee (5%)
Operational/Managerial Control (5%)		 Apr 1, 2018
Apr 1, 2018

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1247616000000",
    "number": "1013919034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 N 3RD AVE",
            "city": "CLAYTON",
            "state": "NM",
            "postal_code": "884153302",
            "telephone_number": "575-374-8313",
            "fax_number": "575-374-2064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 N 3RD AVE",
            "city": "CLAYTON",
            "state": "NM",
            "postal_code": "884153302",
            "telephone_number": "575-374-8313",
            "fax_number": "575-374-2064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN WORMER",
        "first_name": "MARK",
        "middle_name": "EDWARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2009-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NM",
            "license": "81333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "060000475",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05645",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clayton, NM

Sources for this page

Verify at the official NPI Registry.